Prostate cancer

The prostate gland is the male sex gland. It produces a thick fluid that forms the majority of the semen. The prostate gland in a young male is a walnut-sized gland and measures approximately 20cc. The average prostate in a patient with prostate cancer is approximately 40cc. The prostate gland is located below the urinary bladder and in front of the rectum.

The prostate surrounds the upper part of the urethra, the tube that empties urine from the bladder. The prostate gland usually needs male hormones to function. The male hormone is testosterone, which is made by the testicles. Approximately 10% of male hormones are produced in small amounts by the adrenal glands, which are located above the kidneys.

A malignant tumor is formed when cells in the prostate gland grow more quickly than in a normal prostate; this process leads to prostate cancer. Prostate cancer develops from the growth of the cancerous cells within the prostate gland and is probably the fourth most common cancer found in India. Although the cause of prostate cancer is still unknown, a family history of prostate cancer, a high-fat diet, and age are possible markers.

Commonly diagnosed Benign Prostatic Hypertrophy (BPH) does not increase the risk of developing prostate cancer, according to most clinical studies. Prostate cancer is sporadic in young patients. The risk of prostate cancer increases drastically with age. Almost all prostate cancers are adenocarcinomas. Another type of cancer, such as transitional squamous cell carcinomas and small cell cancers, is very rare.

The incidences of prostate cancer have been on the continuous rise for more than two decades now. However, due to tests like prostate-specific antigen (PSA) & improved technology, now there is better management of the disease. Prostate cancer tends to arise from the peripheral zone of the prostate.

Patients are often asymptomatic at diagnosis; cancer can remain in the prostate gland (localized) or spread (metastasize) to nearby lymph nodes, the bladder, the rectum, or more remote organs such as the bone and liver. The bone is the most common site of prostate cancer metastases.

Causes of prostate cancer

• Age (more than 50 yrs )
• Family history of breast, prostate or ovarian cancer
• High-fat diet
• High testosterone levels

Who is at risk ?

The cause of prostate cancer is unknown at this time. Many factors increase the likelihood of developing prostate cancer.

Age : Prostate cancer is uncommon in patients under 50 years old. More than 80% of all prostate cancer patients are older than 65. It is a known fact that the chances of developing prostate cancer are higher in males older than the age of 50. It is recommended that these individuals undergo an annual PSA screening test and digital rectal exam.

Family History : Prostate cancer may have a genetic link, but the human gene related to the disease has not been discovered. Male patients with a positive family history of prostate cancer in the father or brother have a much higher risk (two- to seven-fold increase) of developing prostate cancer. The risk gets even higher if several relatives have been affected, especially if they were young at the time of diagnosis.

Many elderly males are diagnosed with BPH. Studies have indicated that BPH is not related to a higher risk of developing prostate cancer. However, patients with BPH are recommended to have an annual PSA test and digital rectal exam for screening purposes.

Diet : A high-fat diet may increase the risk of developing prostate cancer. Recent studies have indicated that a diet high in lycopenes (found in fruits and vegetables), turmeric (curcumin), vitamin E, and selenium may lower the risk of developing prostate cancer.

Symptoms of prostate cancer

• Frequent urination
• Pain in urination
• Blood in the urine
• Blood in the semen
• Back pain

Prostate cancer usually does not have any symptoms in the early stages. Early cases are either diagnosed because the physician performs a digital rectal exam (DRE) and feels an abnormality in the gland or because the PSA blood test is used to screen for cancer.

The presence of symptoms usually indicates an advanced stage of the disease. Advanced prostate cancer can lead to many symptoms, such as weakness in urinary symptoms, such as weakness in the urinary stream, difficulty in the initiation of urine, difficulty in emptying the urine completely, a burning sensation while urinating, blood in the urine, weight loss, or bone pain.

However, these symptoms are not specific for cancer and, in fact, are much more commonly associated with other prostate and bladder conditions, such as benign prostatic hyperplasia (BPH) or maybe a bladder infection. The most common site to spread is to the bones; pain in the lower back, ribs, pelvis, and other bony structures are the most common presenting symptoms in the patients with bony metastasis.

When the patient has a metastatic disease to the spine, symptoms of spinal cord compression may develop. Common symptoms found in spinal cord compression include pain, urinary incontinence, paraplegia, and paralysis. Spinal cord compression is a medical emergency that may cause permanent paralysis if not treated appropriately within a limited amount of time.

Diagnosis of prostate cancer

• PSA blood test
• Digital rectal examination
• Biopsy
• MRI
• CT Scan

Before the discovery of Prostate Specific Antigen (PSA), prostate cancer was usually diagnosed by a physical examination. A physical examination (digital rectal examination) typically reveals an induration or nodularity of the prostate. Nodules of prostate cancer are generally hard and painless. Patients with advanced prostate cancer may also suffer from bony pain (from bony metastases) and inguinal lymphadenopathy.

PSA is a protein that serves as a tumor marker unique to the prostate gland. A PSA test significantly increases the yield of a digital rectal examination in the diagnosis of prostate cancer. PSA blood tests can also detect prostate cancer of a very low volume and are used in the initial diagnosis and the diagnosis of recurrent diseases after the treatment.

PSA is relatively sensitive and specific for the screening of prostate cancer, but it should be done with physical examination and other imaging studies, such as transrectal ultrasound (TRUS), for the diagnosis of the disease. The standard method to diagnose prostate cancer is a true-cut prostate biopsy after a positive serum PSA test or DRE.

A bone scan is very sensitive in detecting bony metastases for prostate cancer in patients with high serum PSA levels or bony pain. CT scans and MRIs are used to evaluate the extent of prostate cancer in the pelvis. They are usually used to detect the lymphadenopathy in the pelvis and low abdomen.

Staging

If cancer is found in the prostate, your physicians need to know the stage and extent of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The doctor may use various blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these findings.

The result of staging tests helps the doctor decide which stage best describes a patient’s disease. The clinical and pathological stage of the disease is one of the most important prognostic factors for a patient’s survival.

Treatment depends on the stage at which the cancer is found and also on the age and health status of the patient. Surgery and radiation therapy are options for cancer that is confined to the prostate. Standard treatment involves either removal of the entire prostate gland (radical prostatectomy) or radiation therapy aimed at the pelvic area.

• Staging
• Radiotherapy
• Hormone therapy
• Surgery

Will I receive hormone therapy ?

Hormone therapy prevents the prostate cancer cells from getting the male hormones they need to grow. When a man undergoes hormone therapy, the level of male hormone is decreased. The drop in hormone level can affect all prostate cancer cells, even if they have spread to other parts of the body.

For this reason, hormone therapy is called systemic therapy. Not every patient diagnosed with prostate cancer needs hormone therapy. Hormone therapy is usually used prior to surgery or radiotherapy to reduce the volume of the prostate gland.

Patients with poorly differentiated disease, locally advanced disease, and severely enlarged prostate glands should receive hormonal treatment before their definitive therapy. Prostate cancer that has metastasized to other parts of the body usually can be controlled with hormone therapy for a period of time.

CAR T-Cell therapy for treatment of prostate cancer

A recently created immunotherapy for the treatment of tumors is called chimeric antigen receptor-engineered T-cell (CAR-T) therapy. Its usage in the treatment of solid tumors, such as prostate cancer, has been investigated because CAR-T therapy has demonstrated remarkable efficacy in the treatment of CD19-positive hematological malignancies.